Backflow Prevention Device Inspection And Maintenance Report Form (Page 2 of 2) in pdf

Backflow Prevention Device Inspection And Maintenance Report Form Page 2

fitter/contractor to perform the necessary repair within fourteen (14) calendar days of the failure test or from the discovery of the defect

as required by the Massachusetts Drinking Water Regulations, 310 CMR 22.22(13)(b). The repaired device must be re-tested by a

Massachusetts certified backflow prevention device tester.

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A Backflow Prevention Device Repair Information & Re-test Report Form must be completed to report the repair(s) conducted and

the re-test result.

P://OPS/Xconn/Inspection & Maintenance Report (Revised 07/05/2012)

Backflow Prevention Device Inspection And Maintenance Report Form Page 2